The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas

• Published in: The Journal of rural health Vol. 37; no. 4; pp. 734 - 744
• Main Authors: Nasim, Urooj, Morgan, Zachary J., Peterson, Lars E.
• Format: Journal Article
• Language: English
• Published: Washington Wiley Subscription Services, Inc 01-09-2021
• Subjects: Bivariate analysis; Doctors' assistants; Families & family life; family physicians; Health care; Health care access; Health services; Medical personnel; Nurse practitioners; Physicians; Poverty; Registration; Regression analysis; Regression models; Rural areas; Rural communities; rural health; Rural urban continuum; Rurality; Scope of practice; Statistical analysis; Statistics; Urban areas; Urban environments
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12540

Purpose
Scope of practice of family physicians (FPs) has been decreasing overall. Our objective was to determine if the distribution of declining scope occurs across urban and rural settings.
Methods
We used secondary data from practicing FPs collected on the American Board of Family Medicine examination registration demographic questionnaire from 2014 to 2016 on scope of practice merged with county‐level data from the Area Health Resources File. Rurality was assigned using 4 population‐based groupings from the Rural Urban Continuum Codes. Outcome measures were scope of practice score (0‐30, higher score reflecting broader scope) and provision of specific types of care/procedures. Bivariate statistics assessed changes in scope of practice over time. Adjusted regression models tested associations between time, physician, practice, and county characteristics with scope of practice score.
Findings
Our sample was 27,343 practicing FPs. Overall, the scope score decreased from 15.5 to 15.0 (P value < .05) but was significant only for urban settings. Regression analysis found that scope decreased each year (β = –0.15), broader scope for rural FPs, and no interaction between year and rural.
Conclusions
The decrease in FP scope of practice is largely an urban phenomenon. FPs in rural areas have a broad scope of practice, which may ensure access to care in rural areas that rely on FPs to provide a large portion of health care services. However, county characteristics like persistent poverty and the presence of nurse practitioners, physician assistants, and other physicians were associated with changes in scope that may modify the gains associated with rurality.